关节镜下先进人工韧带加强系统人工韧带重建膝关节后交叉韧带

目的 探讨关节镜下应用先进人工韧带加强系统(LARS)人工韧带重建膝关节后交叉韧带(PCL)的可行性及近期疗效.方法 选择PCL损伤的患者15例,后抽屉试验为Ⅱ～Ⅲ度,均存在后方不稳定的症状和体征,但无后外角等严重复合损伤.应用法国LARS人工韧带于关节镜下行单束重建膝关节PCL术.比较术前与术后随访3、6及12个月的Lysholm、Tegner评分.结果 术后无1例发生严重的并发症,无滑膜炎产生,无韧带断裂和松动.术后3、6及12个月的Lysholm评分分别为(73.87±3.16)、(90.14±1.99)及(90.86±1.17)分,均显著高于术前的(48.8±5.11)分(P值均<0.01),术后6个月与12个月的Lysholm评分的差异无统计学意义(P0.05).术后3、6及12个月的Tegner评分分别为(5.60±0.51)、(7.53±0.52)及(7.73±0.46)分,均显著高于术前的(1.93±0.96)分(P值均<0.01),术后6个月与术后12个月的Tegner评分的差异无统计学意义(P0.05).根据国际膝关节评分委员会的评分标准分级为A 12例,B 3例.结论 对于单纯性膝关节PCL断裂并有手术指征的患者,采用关节镜下LARS人工韧带重建PCL的创伤小,可取得较好的疗效.

Reconstruction of arthroscopic posterior cruciate ligament by ligament advanced reinforcement system artificial ligament

Objective To study the feasibility and short-term effects of arthroscopic posterior cruciate ligament (PCL) reconstruction using the ligament Advancement Reinforcement System (LARS). Methods This retrospective analysis included 15 patients (male/female; 2/13), with a mean age of 25.3 years. All patients were diagnosed as having isolated posterior ligament tears, with an average posterior laxity of Ⅱ-Ⅲ degrees according to post drawer test preoperatively. The procedures were performed averagely 56 days after the accident. Arthroscopic reconstruction was performed in all patients. Posterior cruciate ligament repair was achieved with the adjunction of a polyester ligament (LARS) using one strand technique. Patients were followed up for 3, 6, and 12 months after operation, and the Lysholm and Tegner scores were compared with those before operation. Results There were no complications (synovitis, spontaneous tear) directly related to the synthetic ligament after operation. The Lysholm scores at 3, 6, and 12 months after operation were(73.87 ± 3. 16), (90.14±1.99), and (90.86±1. 17), respectively, which were significantly higher than that before operation (48.8±5.11, P<0. 001), but the scores were not significantly different at 6 and 12 months after operation. The Tegner scores at 3, 6, and 12 months after operation were(5.60 ± 0.51), (7.53 ± 0.52), and (7.73 ± 0.46),respectively, which were significantly higher than that before operation(1.93 ± 0.96, P<0. 001), but the Tegner scores were not significantly different at 6 and 12 months after operation. The overall IKDC score was A in 12 cases and B in 3 cases. Conclusion LARS artificial ligaments can rapidly promote the recovery and has satisfactory outcome for patients with simple knee joint PCL rupture. The procedure is minimal invasive, easier to manipulate under arthroscopy. The technique spares tendon stock and can be proposed for major posterior cruciate ligament laxity.